1. Slipped capital femoral epiphysis (SCFE)‏

2. SCFE Posterior and Medial displacement of the femoral capital epiphysis on the femoral neck through sudden or gradual deformation of the sub-capital growth plate

3. Incidence 3/100,000 in whites 7/100,000 in blacks Age: –Males 12-16 years –Females 10-14 years M-F 2,4-1 L>R, bilateral in 25%

4. Etiology Mechanical – overload due to obesity, decreased anteversion, changes within physeal plate Inflammatory – synovial inflammation? Hormonal – obesity, hypogonadal features in boys, secondary and primary hypothyroidism, panhypopituarism, hypogonadal conditions, renal osteodystrophy, growth hormone therapy Trauma

5. Predispositions Obesity Rapid growth Endocrinopathies –Hypothyroidism –Renal osteodystrophy –Pituitary deficiency –GH deficiency when treated with GH as this causes rapid growth

6. Symptoms Limp Pain –Groin –Femur –Knee Lateral rotation aggravated when hip is flexed Decreased internal rotation

8. Classification Acute slip – sudden, severe, fracture-like pain in the upper thigh after trauma Chronic slip – a few months history of vague pain in the groin, upper thigh and limp Acute on chronic slip – prodromal symptoms with exacerbation of pain

9. Classification 0 – pre slip I – <30º (mild slip)‏ II – 30º – 60º (moderate slip)‏ a – 30º - 40º b – 40º - 50º c – 50º - 60º III - >60º (severe slip)‏

10. Head-neck angle

11. Southwick- head-shaft angle

12. Classification - Loder 50%0%Avn 47%96%Good prognosis More severeLess severeSeverity of slip ImpossiblePossibleWeight bearing UnstableStable

13. Klein’s Line

14. Radiographs

15. Treatment Stabilisation of epiphysis and prevention of further slippage Stimulation of physeal plate arrest Functional improvement by restoration anatomy in severe cases

16. Treatment 0 and I – in situ stabilization II - in situ stabilization or inter-, subtrochanteric femoral osteotomy III – subcapital femoral neck osteotomy, inter-, subtrochanteric femoral osteotomy

17. Stabilisation

20. Prognosis The majority of patients will be able to return to most sports and activities at approximately 3-6 months post-operatively. Removing the hardware is not necessary unless the patient develops pain or there is a problem with the screw itself. Because of the high association of bilaterality seen in SCFE (approx 25-40%), patients will need to be closely monitored to ensure that the contralateral hip does not slip.

21. IRRITABLE HIP (observation hip, toxic synovitis, transitory coxitis, coxitis serosa, coxalgia fugax, phantom hip, transient synovitis)‏

22. Epidemiology Most common cause of hip pain Reported incidence is 1 in 1000 From 9 months to adolescence (usually between age 3 and 8 yrs -peak age is 6 yrs)‏ More common in boys (2:1)‏ Whites Never bilateral

23. Etiology Bacterial/viral infection Trauma Allergic reaction

24. Natural history Limited duration of symptoms (average 10 days- may be as long as 8 weeks)‏ Recurrence uncommon (< 10%)‏ May be mild radiographic changes in hip Coxa magna and femoral neck widening Association with perthes disease in 1.5%

25. Symptoms Acute hip pain (thigh, groin or knee) Limp with or without pain Stance phase shorter for affected limb Slightly raised temperature Hip held in flexion, external rotation and abduction Protective muscle spasm One side affected

26. Diagnosis Clinical examination USG- may show effusion Rtg- usually normal Laboratory- may be mild elevation of WBC, ESR (OB)>20

27. Differential diagnosis Perthes disease Septic arthritis Osteomyelitis Juvenile rhemoatoid arthritis Slipped femoral epiphysis

28. Treatment Bed rest and analgesia until full ROM achieved Non-weight-bearing Traction only for severe cases NSAIDs- Naproxen 10mg/kg/d Partial weight bearing on crutches until limp resolves